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Updated: Nov 30, 2025
Autonomic Function Following Concussion in Youth Athletes: An Exploration of Heart Rate Variability Using 24-hour Recording Methodology
Published on: September 21, 2018
The utility of heart rate variability as a prognostic factor in children with traumatic brain injury
Marta João Silva1,2, Natália Antunes2
1Pediatric Intensive Care Unit, Centro Hospitalar Universitário São João , Porto, Portugal.
Insights
A decrease in heart rate variability (HRV) may indicate a worse outcome for children with traumatic brain injury (TBI). This finding suggests HRV could be a prognostic factor, but more research is needed.
Area of Science:
- Pediatric Neurology
- Autonomic Nervous System Function
Background:
- Traumatic brain injury (TBI) in children can lead to complex neurological deficits.
- Assessing prognosis in pediatric TBI is crucial for guiding treatment and rehabilitation.
- Heart rate variability (HRV) reflects autonomic nervous system (ANS) regulation.
Purpose of the Study:
- To review existing literature on the association between HRV and outcomes in pediatric TBI.
- To evaluate the potential of HRV as a prognostic factor in children with TBI.
Main Methods:
- A literature review was conducted using databases such as PubMed, World of Science, and Scopus.
- Studies published between 1996 and 2017 focusing on HRV in pediatric TBI were included.
- Seven relevant studies were analyzed.
Main Results:
- A lower LF/HF ratio (a measure of HRV) was observed in patients who became brain dead.
- Patients with better prognoses exhibited significantly higher LF/HF ratios.
- HRV parameters showed significant changes within hours of hospitalization.
Conclusions:
- HRV may serve as a valuable indicator of neurological damage severity and a prognostic factor in pediatric TBI recovery.
- Further prospective studies are required to establish definitive HRV thresholds and validate its clinical utility.
- Recommendations for routine HRV monitoring as a prognostic tool in pediatric TBI are premature without further evidence.
Objective:
This study aimed to do a literature review to prove the hypothesis that a change in autonomous nervous system regulation, more precisely a decrease in heart rate variability (HRV), is associated with a worse outcome and could be used as a prognostic factor in children with TBI.
Methods:
Databases (Pubmed, World of Science and Scopus) studies were conducted from 1996 to 2017, considering HRV in children with TBI. Seven studies were analyzed.
Results:
Patients that became brain dead had a markedly lower LF/HF ratio, with a significant decrease after the first few hours of hospitalization. Patients with a more favorable prognosis had significantly higher LF/HF ratios.
Discussion:
The HRV can be useful when determining the severity of neurological damage and a prognostic factor in the evaluation of its recovery. However, to assess the true value of HRV monitoring in children with TBI, a prospective study with identified thresholds for HRV, comparison to the standard methods of assessment and predictions should be made blinded to outcome at admission and then through the clinical course including the post-acute phase of rehabilitation. In the absence of this, any recommendation for its use as a prognostic tool may be premature.
